Hogan Injury > Medical Malpractice > Medical Records Release Form

Medical Records Release Form

You need to conduct an initial review of your medical records before you can actually file a legal claim. Some personal injury lawyers have medical professionals on their staffs who assist in the records review process and then advise the attorneys on the medical aspects of the case. In some cases, the lawyers will not be competent enough to evaluate the scenario. In times like this, he will need the assistance of a physician in handling the case. In any event, your attorney will need you to sign a release form like the one below so that your medical providers are authorized to provide a copy of your records to your lawyer.

Patient’s name _____________________ Date of birth ____/____/____Social Security Number ______-___-_______

Address ______________________________________________
______________________________________________
______________________________________________
______________________________________________

Telephone number (____) ____-_______

Please release my medical records from:

Name of provider __________________________________________
Provider’s address __________________________________________
__________________________________________
__________________________________________
__________________________________________

TO:

[ATTORNEY’S NAME AND ADDRESS HERE]

Please release all records, including but not limited to, progress notes, operative notes, laboratory test results, diagnostic tests, and x-rays.

I HEREBY AUTHORIZE THE RELEASE OF MY MEDICAL RECORDS AS PROVIDED ABOVE.

_______________________________________ Date: ______________________________
Patient’s Signature

Would you like to discuss your legal matter?

PHONE

image description
Jack Morgan CALL US! 866-205-4971

We will assist in scheduling new and existing clients for all offices. For initial consultations we will ask you a few questions and then find the best time for you to talk to one of the lawyers that best fits your legal matter.

Call us or use the email form and we will follow up with you right away.

EMAIL

The Law Offices of Hogan Injury will provide you with personalized attention and guidance. Protecting your rights is our main objective. We have been representing clients for the past 30 years and our experienced team of attorneys will advise you of the legal consequences of every decision you take.